Identify gaps in
provision
Integrate in job
Think system-wide
descriptions and
Personal
Development
Plans
Set clear targets
Systemic action across
for type and level
sectors based on
of intervention
common language
Identify learning
and development
needs
Preface
David quickly stubbed out his cigarette and pushed his hands deep inside his dressing gown pocket
to guard against the biting wind. “Hi Pete, bit nippy today. Ridiculous habit I know but you know
how it is...”
“Sure do, Mr Timmons, I was a 20 a day man myself, I can hardly believe that now.”
“Was?” asked David, making polite conversation.
“Yeah, been stopped just over two years now, it wasn’t easy, but it was the best thing I ever did.”
Pete answered as the two men walked briskly towards the main entrance. “I wanted to play football
with my lads see and well, I just couldn’t keep up.”
“Must have been hard...”
“I’ll not lie to you Mr Timmons, it was. But I went to my GP and he gave me some help and then I
joined this group you see and I reckon that made all the difference. See I had tried before but it
hadn’t worked. The support of others, that’s what did it for me. Kept me on the straight and
narrow.”
“Mmm, not sure that’s my thing really,” replied David pushing his hands deeper into his pockets.
“I know what you mean; I wasn’t keen at first but I tell you, it was great, no-one judged you, just
supported you. But at the end of the day it’s what’s right for you. You got kids Mr Timmons?”
“Yeah, a boy and a girl. Nancy’s eighteen now but Billy, well he was a surprise, he’s 3.”
“Ah, not be long before he’s dragging you out for a kick about then. I can tell you it’s a lot easier if
you’re not gasping for air.”
“Good point,” remarks David as he reached for the door finding himself a little breathless.
“Look, it may not be your thing and maybe you’re not ready yet but, if you think you might want to
give up, the details of the group I went to are on the notice board. Just over there, see?”
“Oh, yeah I see,” answered David.
“Well, best get a wriggle on, my shift starts in five and I know there will be a pile of deliveries to be
made – it’s Tuesday. See you later Mr Timmons, I’ll be up on your ward delivering your tea at about
five.”
“Aye, see you then Pete,” said David as he wandered over to the notice board.
As he reached the lift Pete turned and watched Mr Timmons reading the notice for the smoking
cessation support group. He allowed himself a little smile of satisfaction as he thought, “That may
be one contact that counts.”
Page | 2
Contents
Foreword
4
Introduction
5
Service Commissioners
7
Service Providers
8
Guidance to embed the Framework in services
9
Education Commissioners
10
Education Providers
11
Guidance to embed the Framework across health education
12
Human Resources
13
Individuals
14
Guidance to embed the Framework through organisation development
15
Links to resources and further guidance
16
Supplement A: The development of the approach in Yorkshire and the Humber
17
Page | 3
Foreword
Public Health is currently undergoing radical change and with it comes a challenging agenda for policy-makers,
commissioners, employers and individuals as well as those responsible for supporting learning. With the shift from health
to a local authority-led public health service, the necessity to build capacity, capability and confidence for the whole
workforce across all services and sectors becomes imperative. The opportunity to garner a wider public health workforce
in the promotion of healthy lifestyle choices brings with it the need for robust, inclusive systems that ensure everyone
understands how to communicate health and prevention messages effectively.
The Prevention and Lifestyle Behaviour Change: a Competence Framework (Framework) provides a mechanism to ensure
systematic, measurable and evidenced development of workforces to meet the challenge. Developed over the past four
years the framework is informed by NICE guidance, the KSF (Knowledge and Skills Framework), staff reviews, National
Workforce Competences (NWC) and National Occupational Standards (NOS). Whilst these clearly define the need and the
competencies, the framework also acknowledges the complexity and the challenging factors affecting health and
wellbeing behaviour and operates from the premise of ‘starting from where the person is’ and considers behaviour
change in the context of the wider and social determinants of heath.
The framework provides the architecture to facilitate workforce strategies and development activities that deliver both
the public health and NHS policies, strategies and related Outcomes Frameworks designed to improve the health and
wellbeing of individuals and populations.
As well as the clear benefits for commissioning, service provision and improving the capacity of the workforce, the
Framework also provides a barometer for organisations’ investment in staff health and wellbeing and associated
improvements in productivity.
Good health is now increasingly recognised as everyone’s business. The Public Health Responsibility Deal (2011) is the
Government’s way of drawing on the potential of employers in both the private and public sectors to help tackle health
inequalities through the influence they have over health in the workplace, alcohol, food and physical activity. The
Framework can assist the initiative by providing a workforce strategy to facilitate the achievement of outcomes through a
competent, capable and confident workforce.
Whilst the Framework is designed to assist organisations and individuals, the ultimate beneficiaries are of course people,
communities and populations. ‘Making Every Contact Count’ is a powerful tool to improve the health and wellbeing of
the public.
Page | 4
Introduction
Central to the ambition of ‘Making Every Contact Count’ (MECC) is the promotion of positive health and lifestyle
behaviour change in individuals, communities and populations. The Prevention and Lifestyle Behaviour Change: a
nd
Competence Framework (2 edition, NHS Yorkshire and the Humber 2010) is the region’s approach underpinning the
widespread adoption of ‘Making Every Contact Count’. In line with NICE Guidance to, ‘equip practitioners with the
necessary competencies and skills to support behaviour change, using evidence-based tools’ (Guidance for Behaviour
Change at Population, Community and Individual Levels, NICE, 2007) the Framework promotes the use of evidence-based
theories and models to develop, implement and evaluate behaviour change initiatives. It is not intended to be limited in
its reach to a specific sector or role but to act as an inclusive Framework focused on behaviour change skills across roles,
organisations and sectors. Developing basic standards aimed at frontline staff; the Framework assists commissioners and
providers to equip workforces with the capacity and skills to assist people to make positive behaviour changes to improve
their health and wellbeing.
The Framework is a supportive mechanism that enables benchmarking across geographical regions, workforces and
services. The aim is not to create new roles or workforces but to ensure that existing workforces can feel confident and
competent to ‘make every contact count’. It is simple, flexible and universal in application; the workforce functions for
delivering behaviour change are clearly defined in three of the levels:
Level 1: brief advice and signposting
Level 2: behaviour change intervention, e.g. brief intervention or motivational interviewing
Level 3: behaviour change intervention programme, e.g. weight management programmes
Level 4: is specialist practice and therefore not the focus of this activity
Prevention and Lifestyle Behaviour Change: a Competence Framework. The levels defined:
Level 1
Level 2
Level 3
The worker is able to engage with
individuals and use basic skills of
awareness, engagement, and
communication to introduce the idea of
lifestyle behaviour change and to
motivate individuals to consider/think
about making changes to their lifestyle
behaviours.
The worker is able to select and use brief
lifestyle behaviour change techniques
that help individuals take action about
their lifestyle behaviour choices which
may include starting, stopping,
increasing or decreasing lifestyle
behaviour activities.
The worker is able to select and use
appropriate techniques and approaches
to provide support to individuals as they
change their lifestyle behaviours and
facilitate the individuals to maintain
these changes over the longer term.
1.1. Ensure individuals are able to
make informed choices to manage
their self care needs
2.1. Ensure your own actions support
the care, protection and wellbeing
of individuals
3.1.
Enable people to address issues
related to health and wellbeing
1.2. Support and enable individuals to
access appropriate information to
manage their self care needs
2.2. Select and implement appropriate
brief lifestyle behaviour change
techniques with individuals
3.2.
Enable individuals to put their
choices for optimising their
lifestyle behaviours into action
1.3. Communicate with individuals
about promoting their health and
wellbeing
2.3. Enable individuals to change their
behaviour to improve their own
health and wellbeing
3.3.
Enable individuals to maintain
lifestyle behaviour changes
1.4. Provide opportunistic brief advice
2.4. Undertake brief interventions
Level 4
The worker uses specialist/advanced or lifestyle and behaviour specific behaviour change approaches to support individuals.
Workers at this level will also act as a resource for the support, training and education of others.
Page | 5
Based on work over the past four years across the region, this document aims to offer guidance for commissioners,
providers, Human Resources and individuals to adopt the Framework to ensure both quality and quantifiable progress
towards the ambition of ‘Making Every Contact Count’.
The Application of the Prevention and Lifestyle Behaviour Change Competence Framework
Informing strategy and planning
thorough assessment and planning to meet gaps in the behaviour change role of the
workforce at all levels.
Underpinning commissioning
enables commissioners to quantify expectations and outcomes.
Transforming culture
provides clarity around the public health role and provides organisations with a
common language to consider behaviour change interventions.
Driving workforce development
provides clarity of levels of intervention and identifies education and training needs.
Supporting service provision
provides clarity of roles and responsibilities and identifies support needs.
Assisting workforce planning
identifies knowledge and skills required to deliver health behaviour interventions.
Page | 6
Service Commissioners
The Benefits













Helps to identify gaps in provision
Facilitates role and service redesign
Transforms NICE Guidance into deliverables
Delivers current Public Health agenda
Takes account of wider determinants of health
Supports provision based on population need
Provides clear metrics to performance manage
Promotes consistency
Facilitates system-wide commissioning
Builds on current provision and good practice
Facilitates industrial-scale change
Supports change
Provides common language across sectors and services
Underpinning commissioning, the Prevention and Lifestyle Behaviour Change: a Competence
Framework offers a benchmark and a quality assurance mechanism. Moreover it sets clear targets
for the level and type of provision for behaviour change; supports performance management and
provides a structure to assess the effectiveness, quality and health outcomes of services.
The Prevention and Lifestyle Behaviour Change Competence Framework enables commissioners to
recommend the levels of workforce delivery required to address local priorities, disease areas and
the health and wellbeing of communities. It supports the articulation of the type and level of
prevention and behaviour change services and workforce needed to address the needs of the
population. Wider and social determinants of health are core to the development as it ‘starts from
where the person is’ rather than dealing with a condition, illness or a label.
The Prevention and Lifestyle Behaviour Change: a Competence Framework builds upon and
recognises that many services are delivering ‘Making Every Contact Count’ and are examples of good
practice. It does, however, aim to deliver sustainable ‘industrial scale’ change across all services and
workforces. It ensures lifestyle services and other prevention activities are consistent and
comprehensive. Used as an assessment tool, it can assist in workforce planning, identifying service
and workforce gaps and provide evidence for role redesign or service redesign. Commissioners will
need to consider the impact on existing specialist services of increased referrals from signposting,
referral and brief advice from the wider workforces.
The Prevention and Lifestyle Behaviour Change: a Competence Framework has enabled
commissioners to plan a whole system approach to tackling specific health and wellbeing needs of
the community or population. As it is not role specific, it provides a common point of reference for
contracts with NHS providers; including acute, community and mental health services; primary care
contracts; and community and voluntary sector health development services and contracts.
However, it has also crossed sector boundaries; informing strategy and planning to enable all parts
of the system across the public sector to deliver behaviour change. A number of areas have
reported that the Framework has assisted in transforming culture as it provides clarity and common
language across services, workforces and organisations enabling them to engage in productive
conversation and support change.
Page | 7
Set clear targets
for type and level
of interventions
Identify and
meet gaps in
provision
Tailor workforce
requirements to
population need
Act system-wide
Service Providers
The Benefits















Clarifies roles and responsibilities concerning behaviour change
Identifies learning and development needs
Provides sustainable skills
Delivers current Public Health agenda
Meets NICE Guidelines
Takes account of wider determinants of health
Builds on good practice and current approaches
Builds on current provision and enhances specialist provision
Helps to identify gaps in provision
Promotes consistency
Supports service development and business cases
Benefits the health and wellbeing of staff
Supports change
Facilitates role and service redesign
Improves staff confidence
The Prevention and Lifestyle Behaviour Change: a Competence Framework supports service
provision as it clarifies roles and responsibilities enabling the ‘right person, with the right skills to be
in the right place’ to support individuals, families and communities to address health and wellbeing
behaviours. It builds on existing lifestyle services and other prevention activities to ensure the
workforce is delivering behaviour change interventions across all patient pathways and contracts.
The Prevention and Lifestyle Behaviour Change: a Competence Framework describes levels of
competence and is not prescriptive as to specific interventions or models of behaviour change. It
does not seek to assign a particular approach to a specific role so providers are able to build on best
practice in current services, e.g. smoking cessation, weight management, occupational health
services and wider public facing roles and to recognise those workforces and services already
providing behaviour change.
The Framework works to best effect when it is embedded as a component of workforce planning and
development processes and when competences are integrated in job descriptions, performance
appraisals and personal development plans.
The Prevention and Lifestyle Behaviour Change: a Competence Framework can be used to analyse
the learning and development needs of the workforce, providing minimum standards for
competence required to deliver behaviour change. Relevant to all roles, both clinical and nonclinical, it provides standards to assess the behaviour change capability of the organisation. Used in
tandem with the Making Every Contact Count Assessment Tool (MECCAT), it allows service
providers to assess current levels of capability to inform workforce development plans. It assists
providers to identify service and workforce gaps and provide evidence for role and service redesign.
Through training and education supporting service and workforce redesign gaps in delivering
integrated public health services and outcomes can be addressed. It is not about creating more work
but rather doing what people do, but better. The Pilot Evaluation noted; “Its strength is its simplicity;
it does not require a great shift or extra effort from the normal tasks carried out by the staff
delivering it.” (Making Every Contact Count: Report on the Pilot Study, Nelson et al 2012).
The Framework supports service development and delivery of CQUINS, by providing quantifiable and
measurable outcomes alongside quality assured standards to embed MECC into services.
Page | 8
Clarify roles and
responsibilities
Build on best
practice
Integrate into HR
processes
Identify learning
and development
needs
Address gaps
creatively
Support
development
Use the Framework to ensure
MECC is embedded in quality
assurance processes to assess
effectiveness, quality and
outcomes of lifestyle
behaviour change
interventions.
Provide clear and measurable
targets for lifestyle behaviour
change interventions in all
contracts for NHS
organisations; acute,
community, mental health
services and primary care
contracts. Also in non-NHS
and voluntary sector health
development services and
contracts.
Make an organisation-wide
commitment to embed the
MECC principles throughout
the service.
Strategic planning is required
to embed MECC in all services,
widening frontline delivery of
lifestyle behaviour change to
all staff whether a receptionist
providing level 1 brief advice
or a physiotherapist providing
brief interventions at level 2.
Identify staff in appropriate
roles to deliver lifestyle
behaviour change
interventions as part of their
role.
Evaluate through...
Make a strategic pledge to
ensure the MECC principles
are at the heart of services,
based on population need.
Service Providers
Service Commissioners
Guidance to embed the Framework in services
Evidence in contacts and
strategic plans to ensure
MECC is at the heart of the
services.
Work undertaken to identify
roles supported to undertake
lifestyle behaviour change
interventions, and workforce
needs analysis to assess and
meet training, education and
development needs.
Numbers of staff competent
and confident to deliver
lifestyle behaviour change
interventions at all levels.
Activity levels and referrals.
Identify current levels of
competence and the action
required to meet gaps using
the framework as a
component of workforce
planning and development
planning.
Identify mechanisms to
capture activity, including
referrals to specialist services.
Utilise the Making Every
Contact Count assessment
tool to assess on individual,
team or organisational level
the 5 dimensions: confidence,
competence, personal
development, organisational
preparedness and wider/social
determinants.
Build on best practice in
current services, e.g. smoking
cessation, weight
management, alcohol
reduction, occupational health
services and health trainers.
Encourage cross-organisation
and sector development to
maximize lifestyle behaviour
change interventions.
Page | 9
Consider how opportunities to
implement lifestyle behaviour
change interventions can be
incorporated into service
redesign.
A growing culture of lifestyle
behaviour interventions and
improving health of the
population.
Education Commissioners
The Benefits













Helps to identify gaps in provision
Delivers current Public Health agenda
Meets NICE Guidelines
Ensures education is based on service and population need
Provides clear metrics for quality assurance
Provides minimum standards
Facilitates ‘value for money’ commissioning
Supports benchmarking
Works across all methods of delivery
Supports flexible provision
Builds on current provision and approaches
Builds on good practice
Promotes consistency
The Prevention and Lifestyle Behaviour Change: a Competence Framework underpins education
commissioning by offering quality assurance standards that can be benchmarked and compared. It
provides a minimum standard for training providers and recipients about the knowledge and
competence required to deliver behaviour change.
It assists in identifying the education and training needs provided by partner Higher Education
Institutions (HEI) and education providers by breaking down behaviour change competence into
three generic levels that can meet the needs of the whole workforce. Accordingly, standalone
modules can be commissioned or can be incorporated into wider programmes. Whilst there are
financial implications associated with MECC, most especially around training and education,
commissioned provision can be flexibly applied and therefore prove cost-effective. Additionally,
these costs are fully compensated by potential cost savings in provision as identified by Professor M
Whitfield in his report , ‘Scoping the economic case for the 'Health Behaviour Change' Competence
Framework,’, Whitfield and Machaczek, 2010, which concluded that, the 'Make Every Contact Count'
programme was likely to have profound impact by:
i.
ii.
standards
Seek flexible
solutions
Decreasing the demand for health care and thus its costs (though influencing a healthrelated behaviour change).
More effective use of health care services through increasing the effectiveness and
utilisation of service delivery and treatment.
Creative ways of training the workforce can be considered and the level 1 training has been provided
across the region in bite sized chunks and short (2-3 hours) courses in situ, thereby minimising
service disruption and cost. Currently, NHS Yorkshire and the Humber is developing on-line training
resources at level 1. ‘Train the trainer’ provision has proved useful in assuring sustainability and
cost-effective provision. Additionally, these individuals act as agents for change, providing role
models for the workforce.
The Framework can assist commissioners to identify gaps in provision and source new provision to
address those gaps as required. Additionally, commissioners can ensure provision is based on
population and community need or disease/condition need as each level supports evidence-based
practice and thus does not subscribe to any one behaviour change modality or theory.
Page | 10
Specify minimum
Seek creative
provision
Match provision
to population
need
Education Providers
The Benefits













Helps to identify gaps in provision
Promotes consistency
Supports benchmarking
Delivers current Public Health agenda
Meets NICE Guidelines
Ensures education is based on service and population need
Supports flexible provision
Builds on good practice and current approaches
Works across all methods of delivery
Supports change
Focused on competences
Provides minimum standards
Builds on current provision which can be easily mapped
The Prevention and Lifestyle Behaviour Change: a Competence Framework has been developed in
line with National Institute for Health and Clinical Excellence (NICE 2007) recommendation that
behavioural change training should focus upon key competences and skills along with behaviour
change theories or models. Indicative content can be tailored to the workforce and setting with
appropriate theories and models utilised as agreed with commissioners and tailored to population
need. A key component of the Framework is that ‘it starts from where the person is’ and takes
account of the wider determinants of health. In doing so, it ensures behaviour change is supported
within the unique context of the individual, communities and populations rather than generic
advice which is less likely to address motivation and desire to change. It drives workforce
development as each level provides a minimum standard for training providers and recipients
about the knowledge and competence required to deliver behaviour change.
The Framework supports current provision as it promotes evidence-based practice and thus does
not subscribe to any one behaviour change modality or theory and encourages relevant theories to
be used depending on population and community need or disease/condition need. Therefore,
existing provision can be mapped against the Framework and amended to reflect the competencies
to support quality assured provision.
New provision mapped to the Framework is flexible and transferable. Modules can be standalone,
or form part of more comprehensive programmes. They can be sector specific or applicable across
sectors and workforces.
At a time when resources are scarce training and education can have a huge impact assisting
people to take more responsibility for their own health and wellbeing. In the NHS Yorkshire and the
Humber region, training has been commissioned that focuses on skilling members of the workforce
to deliver training at level 1. This ‘train the trainer’ approach ensures that behaviour change
training is both sustainable and good value. Quality level 1 training can be delivered in a matter of
hours and can be delivered to a team in situ, ensuring good value for money. Other methods of
delivery are being explored, including online provision.
It is important to consider the human dimension of behaviour change in terms of the workforce and
their personal lifestyle as well as that of the clients. Forms of blended learning and practice
sessions to test the complex nature of behaviour change are required to ensure confidence and
competence.
Page | 11
Focus on key
competencies and
skills
Map existing
provision to
assure quality
Provide flexible
and transferable
provision
Design delivery to
service need
Provide reflective
learning
Develop a shared
understanding of workforce
requirements with partner
health, social care, local
authority and third sector
organisations.
Understand the workforce
needs of employers and
students.
Evaluate through...
Identify what lifestyle
behaviour change education
and training needs to be
purchased from partner
HEIs/education providers
through developing a shared
understanding of the wider
workforce and service
requirements, including endto-end workforce planning
process.
Education Providers
Education Commissioners
Guidance to embed the Framework across health education
A range of courses are offered
to address a range of lifestyle
behaviour change
interventions.
Course evaluations
demonstrate an increase in
competence, confidence and
support to undertake
behaviour change when back
in practice.
Commission appropriate
education and training that
will enable the workforce to
develop the competence and
confidence to deliver lifestyle
behaviour change
interventions at defined
levels.
Map current and future
education provision against
the framework levels.
Courses are mapped against
the framework with clear
objectives.
Design and redesign
programmes and modules
that are specifically focused
on behaviour change
interventions using current
best evidence.
Education provision linked to
NHS and PH Outcomes
Frameworks to illustrate how
education contributes to
delivering outcomes.
Quality assure education
providers to assess if
commissioned provision is fit
for purpose, for example
using data from the MECCAT.
Review the learning needs of
students on other courses or
programmes and identify
where it would be
appropriate to introduce
behaviour change elements as
part of the course or
programme.
Systematic review of current
provision.
Source new provision and
commission to address any
gaps as required.
Use the competence
framework to inform the
development of any new
courses.
New courses are mapped
against the framework.
Improvement in baseline skills
as evidenced through the
Making Every Contact Count
assessment tool or similar
assessment tool.
Incorporating the guidance set out in the NHS North West Public Health Teaching Network report,
‘Commissioning training for behaviour change interventions: evidence and best practice in delivery,’ (Powell
and Thurston 2009).
Page | 12
Human Resources
The Benefits



















Clarifies roles and responsibilities concerning behaviour change
Identifies learning and development needs
Provides sustainable skills
Delivers current Public Health agenda
Meets NICE Guidelines for workforce development
Supports flexible learning
Builds on good practice and current approaches
Takes into account current experience and learning
Builds on current provision and enhances specialist provision
Helps to identify gaps in provision
Promotes consistency
Supports service development and business cases
Benefits the health and wellbeing of staff
Promotes transferable skills
Supports change
Supports culture change
Facilitates role and service redesign
Supports professional development
Improves staff confidence
The ambition of ‘Making Every Contact Count’ provides an opportunity to transform the culture of
services and the way we deliver services to the public. Individual responsibility is at the heart of
adopting healthy lifestyle choices and improving personal health. Often, people need education,
support and assistance to exercise this personal responsibility. Whilst traditionally seen as the
domain of Public Health, prevention and lifestyle behaviour change is now clearly within the remit
of the all workforces and the impact those workforces could have is immense. The Prevention and
Lifestyle Behaviour Change: a Competence Framework provides a foundation and key indicator for
the integration of public health and NHS policy, strategies and Outcomes Frameworks into
workforce strategies and development opportunities.
The Framework will assist in delivering a systematic and planned transformation of services. It
supports the planning and development process, identifying training needs and measuring whether
those gaps are being closed. In the first instance, the responsibilities need to be set out in job
descriptions and form part of the appraisal process.
Training to meet behaviour change need not be expensive and time consuming. At level 1, training
can be delivered in 2-3 hours and can be delivered in groups, online or through bite sized chunks
during team meetings. Some organisations have developed their own ‘trainers’ in-house to ensure
sustainability and cost effectiveness.
There are intrinsic links between staff and workplace health and well-being and this large scale
change to facilitate appropriate behaviour change interventions in normative workforce practice.
Raising awareness of health behaviours through training and development also has a positive
impact on the health and wellbeing of the workforce, thereby potentially reducing sickness
absence.
Page | 13
Make MECC
everyone’s
business
Include
responsibility in
job descriptions
Develop flexible
training solutions
Improve staff
health and
wellbeing
Individuals
The Benefits











Delivers current Public Health agenda
Meets NICE Guidelines
Supports flexible learning
Takes into account current experience and learning
Influences your personal health and wellbeing
Confidence in practice
Supports and recognises individual as employee
Supports and recognises individual as member of a community
Promotes transferable skills
Supports professional development
Identifies learning needs
The ambition of ‘Making Every Contact Count’ will only be realised by the actions of individuals to
make the most of opportunities to advise, support, signpost and undertake more complex
behaviour change interventions with those with whom they have contact. Whilst traditionally seen
as the domain of Public Health, prevention and lifestyle behaviour change is now clearly within the
remit of many more sectors and services and therefore the ambition grows exponentially. But the
idea for some is daunting; there is the fear of a recipient’s response, concern over one’s own
personal behaviour standing up to scrutiny and anxiety about having the right skills and confidence
to be effective. But, as the Pilot Evaluation noted, these barriers are being effectively addressed
through training, with one participant noting, “The training is perfect – it’s simple and it’s easy and
it’s short. It’s very well tailored to lay people and non health professionals and that is fabulous,”
(Making Every Contact Count: Report on the Pilot Study, Nelson et al, 2012).
The Prevention and Lifestyle Behaviour Change: a Competence Framework is a tool for personal
and professional development. Individuals can compare their current known levels of competence
against the competences within the framework through the Making Every Contact Count
assessment tool and identify any gaps. Training needs can then form part of personal development
sessions and planning and with continuous personal development.
There are opportunities to become an ‘agent of change’ influencing colleagues and teams and
becoming a role model. Benefits can extend beyond the workplace, with people reporting the
impact training and development in behaviour change has had personally and within their families
and communities.
Page | 14
Tackle personal
and professional
barriers
Assess your
current capability
and identify gaps
Enjoy benefits
beyond the
workplace
Make a personal commitment
to make every contact count
with your service users.
Evaluate through...
Make MECC an organisationwide commitment to support
staff and for staff to support
their clients.
Individuals
Human Resources
Guidance to embed the Framework through organisation development
Individuals understand their
responsibility to ‘making every
contact count’.
Support the development of
effective partnerships within
Human Resource and
Organisational Development
teams to ensure competences
are embedded in workforce
planning and development
processes.
Assess your current level of
competence using the Making
Every Contact Count
assessment tool or other
practices of self reflection.
Individuals, teams and
departments are aware of
their responsibilities,
contributions and capabilities.
Ensure competences are
embedded in job descriptions
and performance appraisals.
Understand your contribution
and responsibility to MECC.
Increased behaviour change
activity and increase of uptake
of specialist services.
Ensure the framework is used
as a component of workforce
planning and development
processes and cycles and use
the results to plan and
prioritise learning activities.
This process can be facilitated
by using the Making Every
Contact Count assessment
tool.
Seek development
opportunities to underpin
your professional
development.
Contribution of MECC to
workforce strategy or activity
to deliver outcomes
frameworks and service
needs.
Ensure the development, with
Occupational Health Services,
of lifestyle behaviour change
skills to support opportunities
within the workforce for
healthier lifestyles.
Seek support to address
personal lifestyle behaviour
where required.
Continuous workforce
development to improve
lifestyle behaviour change
capability.
Improving workforce health,
as identified through sickness
absence.
Monitor access and service
use.
Use staff survey to capture
data.
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Links to resources and further guidance
Website
A dedicated site that provides help, information and guidance about lifestyle behaviour change and how you can make
every contact count. With e-learning and many helpful links, the site also contains case studies, presentations and tools
for individuals, service providers and healthcare professionals.
www.makingeverycontactcount.com
The Prevention and Lifestyle Behaviour Change: a Competence Framework
Putting the prevention of health problems at the heart of every interaction between Service Providers and the
communities they serve, the framework supports organisations and frontline staff to offer brief but appropriate advice,
including ‘signposting’ services, as part of their everyday contact with people. The Framework can be found at:
http://www.yorksandhumber.nhs.uk/document.php?o=6189
A comprehensive resource describing the competencies, skills and knowledge can be found here:
http://www.yorksandhumber.nhs.uk/document.php?o=6994
MECCAT Making Every Contact Count Assessment Tool
A self assessment tool that individuals can complete to inform them of where they are against the Competence
Framework, the tool can be accessed at www.nwyhelearning.nhs.uk/MECCATtool. A more concise version will be
available soon.
www.nwyhelearning.nhs.uk/MECCATtool
MECC E-Learning – www.makingeverycontactcount.com
An eLearning package has been developed to allow learners at level 1 of the Competency Framework to explore a number
of virtual environments to practice their skills, enabling them to identify characters who would benefit from a ‘healthy
chat’ and then practice their skills and explore the wider social determinants in a safe environment to make every contact
count. The learning will be launched at the beginning of November and will be available via
www.makingeverycontactcount.com
Mobile App
To complement the eLearning package, a mobile application has been developed which will provide ‘just in time’
information to practitioners who would benefit from support and advice on how to approach someone for a ‘healthy
chat’ and make every contact count. The app is still in development and is expected to be launched towards the end of
December 2012
Publications
Making Every Contact Count - Report on the Pilot Study
NELSON, A., DE NORMANVILLE, C., KELLY M., AND PAYNE K. (2012)
http://www.yorksandhumber.nhs.uk/document.php?o=8594
Work redesign and health promotion in healthcare organisations: a review of the literature
KISLOV, R., NELSON, A., DE NORMANVILLE, C., KELLY M. AND PAYNE K. (2012) (ISBN: 978-184387-3495)
Scoping the Economic Case for the 'Health Behaviour Change' Competence Framework.
WHITFIELD, M. AND MACHACZEK, K. (2010) Sheffield Hallam University
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Supplement A: The development of the approach in Yorkshire and the Humber
The MECC approach and the Framework has been conceived, developed and consulted upon over a number of years. It
has involved stakeholders from across the regions and has sought to be inclusive in its development. An essential
component has been to ensure that it is built on robust, evidence-based foundations and is able to be evaluated
thoroughly at each stage. Conceived of prior to the current reform of Public Health, it has proved prophetic in its desire to
industrialise health messages through the involvement of the wider workforces serving communities. Central to the
approach has been the development of the Prevention and Lifestyle Behaviour Change Competence Framework.
The MECC Development Timeline
The Principles
To achieve the degree of cultural transformation required to make a difference through behavioural change, MECC
needed to be robust in its development. Partnering with Sheffield Hallam University and other academic institutions
ensured a scholastic underpinning to the MECC approach and the Framework which promotes the use of evidence-based
theories and models to develop, implement and evaluate behaviour change initiatives.
The development of the Framework and the approach has been a collaborative process, engaging stakeholders
throughout the region through the Public Health Workforce Advisory Group, the MECC Implementation Group and annual
conferences.
As already stated, the approach deliberately sets out to validate the use of simple interventions that can be undertaken
by a workforce at all levels and which are not restricted to the healthcare workforce. It is the industrialisation of quality
behaviour change interventions which MECC hopes to achieve across multiple workforces from all sectors. The
Page | 17
Framework and the MECC approach is currently being taken up by Social Services, the Fire and Rescue Service and the
Police Service to name but a few.
Set in the context of wider social determinants
affecting health, the approach seeks to be holistic in
its application; understanding that the factors
affecting health behaviour are complex and
challenging. Likewise the systems and organisations
that serve the public are complex. The approach
therefore seeks to begin the process at a basic level,
capitalising on varying degrees of interaction with
people and communities and working towards more
specialised assistance as individual needs dictate.
Focused on health behaviour change and not
occupation, ensures that the Framework can be used
across sectors and organisations and is not limited to
health services which people may or may not have
contact with.
Additional tools and resources have been developed to The MECC system and strategy
support the Framework and enable organisations to
commission, train, implement, support and evaluate the
concept.
The Prevention and Lifestyle Behaviour Change: a Competence Framework
The Prevention and Lifestyle Behaviour Change: a Competence Framework is a service and workforce change agent and is
playing an enabling role across all key parts of the NHS and wider workforces. It is not just about training but changing
culture and delivery.
The framework was developed following an extensive review of the evidence base to identify the key skills, knowledge
and levels of practice required by the workforce to deliver lifestyle behaviour change interventions. The resulting
competence clusters and level descriptors were reviewed by subject specialists within and beyond the NHS Yorkshire and
the Humber region. The revised clusters were then mapped against the Skills for Health and Skills for Care National
Occupational Standards (NOS) databases and the wider UK Commission for Employment and Skills database using the
following key principles:








Be patient/client focused and ‘start where the community/individual is’
Be simple and flexible adding value to current good practice
Support the system to change and be generic enough to be added into current services, i.e. reinforce the
commissioning of services
Support responsive and accountable appraisal processes and procedures to enable the workforce to succeed
Support the development of measureable outcomes and the effectiveness/efficiency gains required within the
current public sector environment
Support capacity building across the whole workforce so everyone can respond to opportunities to support or
instigate lifestyle behaviour change but not necessarily be experts, i.e. aware of, able and confident to signpost to
other appropriate practitioners or services
Build a whole system, responsive to health, wellbeing and prevention, not just a programme or illness service
Lifestyle issues are not condition-specific and the complexities of people’s lives should be acknowledged
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Where existing NOS mapped within these principles they were included in the framework, however, there were a number
of NOS identified that did not fully meet these principles. Therefore, locally adapted competences were developed from a
range of existing NOS. The final competences and level descriptors were reviewed by subject specialists using a modified
e-delphi approach and through extensive testing with organisations and individual healthcare staff in the NHS Yorkshire
and the Humber region.
The competences identified in the framework are not intended to be exhaustive, but the framework does attempt to
draw together and present the range of knowledge, skills and performance that is associated with prevention and lifestyle
behaviour change.
The framework has been designed to be simple, flexible and add value to current good practice and methodologies, e.g.
smoking cessation services and health trainer roles. It facilitates service planning in terms of workforce planning and
development. This allows commissioners, service and education providers and individuals to bring together the required
processes and systems to realise the whole workforce change that is needed, rather than focusing on just one particular
part of the workforce.
An academic review of the framework was commissioned by NHS Yorkshire and the Humber and concluded that, ‘MECC is
on course to become sustainably embedded within health and social care practice,’ (Making Every Contact Count: The
Prevention and Lifestyle Behaviour Change Competence Framework Academic Review, De Normanville, Hoskin, Wardle,
2011).
Prevention and Lifestyle Behaviour Change: a Competence Framework. The levels defined:
Level 1
Level 2
Level 3
The worker is able to engage with
individuals and use basic skills of
awareness, engagement, and
communication to introduce the idea of
lifestyle behaviour change and to
motivate individuals to consider/think
about making changes to their lifestyle
behaviours.
The worker is able to select and use brief
lifestyle behaviour change techniques
that help individuals take action about
their lifestyle behaviour choices which
may include starting, stopping,
increasing or decreasing lifestyle
behaviour activities.
The worker is able to select and use
appropriate techniques and approaches
to provide support to individuals as they
change their lifestyle behaviours and
facilitate the individuals to maintain
these changes over the longer term.
1.5. Ensure individuals are able to
make informed choices to manage
their self care needs
2.5. Ensure your own actions support
the care, protection and wellbeing
of individuals
3.4.
Enable people to address issues
related to health and wellbeing
1.6. Support and enable individuals to
access appropriate information to
manage their self care needs
2.6. Select and implement appropriate
brief lifestyle behaviour change
techniques with individuals
3.5.
Enable individuals to put their
choices for optimising their
lifestyle behaviours into action
1.7. Communicate with individuals
about promoting their health and
wellbeing
2.7. Enable individuals to change their
behaviour to improve their own
health and wellbeing
3.6.
Enable individuals to maintain
lifestyle behaviour changes
1.8. Provide opportunistic brief advice
2.8. Undertake brief interventions
Level 4
The worker uses specialist/advanced or lifestyle and behaviour specific behaviour change approaches to support individuals.
Workers at this level will also act as a resource for the support, training and education of others.
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Making Every Contact Count Assessment Tool (MECCAT)
The Making Every Contact Count Assessment Tool (MECCAT) was designed to support both individuals and their
organisations in managing competence development. Currently available online, further versions of the assessment tool
are being developed.
It was designed to allow the individual to identify existing skills and knowledge in relation to the Prevention and Lifestyle
Behaviour Change: a Competence Framework. At the same time, it is also facilitates the organisation’s workforce planning
and its support of staff development and training. The tool includes measures of confidence, competence and
organisational preparedness, and an understanding of the framework by the individual. The outputs of MECCAT are used
to:






Determine current levels of competence based on the Prevention and Lifestyle Behaviour Change: a Competence
Framework
Support staff in using the results to create personal development plans
Identify the continuing professional development and education needs across the workforce
Inform performance management, job design and workforce development
Provide quality assurance that the workforce is competent and fit for practice and purpose
MECCAT considers five main areas associated with individuals and their work environments:
Belief: Making Every Contact Count: The extent to which staff accept the philosophy of the NHS Yorkshire and the
Humber “Making Every Contact Count” initiative and their consideration of wider social determinants of health
Continuing Personal Development: The extent to which staff are making efforts to learn in their roles and keep their
knowledge and skills up to date
Organisational Readiness: Staff perceptions of their organisation and the extent to which it supports them or otherwise
(barriers to performance and change)
Confident Competence: Staff perceptions of their own competence
Capability: The approach that staff adopt towards their work in terms of whether they have the confidence to put their
learning, skills and experience into practice
The MECCAT has been piloted and
tested across the region and beyond
and has raised further areas of
development
which
are
now
underway. Overwhelmingly, it has
been positively received and, along
with the online version, methods of
access are being developed for use
with groups.
Organisational
Readiness
Confident
Competence
Continuing
Professional
Development
Belief
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Capability